{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T08:06:11Z","timestamp":1779091571126,"version":"3.51.4"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["202006170050"],"award-info":[{"award-number":["202006170050"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cam morphology, which is a significant risk factor for hip osteoarthritis, is commonly quantified by the alpha angle (AA). This study aims to explore the potential of the triangular index ratio (TIR) to quantify cam morphology on anteroposterior radiographs by assessing the association between TIR\u2010defined cam morphology and the development of radiographic hip osteoarthritis (RHOA) at 10\u2010year follow\u2010up. Additionally, this study compares the predictive performance of cam morphology as defined by the TIR with AA for RHOA development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Cohort Hip and Cohort Knee study included 1,002 participants recruited from the Dutch population aged 45 to 65 years who presented with first\u2010onset hip or knee pain or both to the general practitioner. The associations between cam morphology hips free of RHOA at baseline (Kellgren and Lawrence [KL] grade &lt;2) and the development of RHOA (KL \u22652) were estimated using logistic regression adjusted for age, sex, and body mass index. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the two measurements (TIR \u22651.05 and AA \u2265 60\u00b0) for predicting RHOA were evaluated, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TIR\u2010defined cam morphology was associated with the development of RHOA at follow\u2010up with an adjusted odds ratio of 2.48 (95% confidence interval [CI] 1.38\u20134.46). The PPVs of cam morphology defined by TIR (70.6%, 95% CI 59.0\u201380.0) and AA (62.3%, 95% CI 53.8\u201370.1) overlapped, as did their sensitivity (TIR: 7.8%, 95% CI 5.8\u201310.2; AA: 12.3%, 95% CI 9.8\u201315.2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cam morphology defined by a TIR \u22651.05 at baseline is associated with the development of RHOA 10 years later. TIR may offer a definition of cam morphology more closely related to RHOA, whereas AA may avoid losing too many target cases. Both methods can therefore be used to define cam morphology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.80052","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T10:15:29Z","timestamp":1775211329000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Triangular Index Ratio as an Alternative Method to the Alpha Angle for Defining the Presence of Cam Morphology: A Prospective Cohort Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1028-5922","authenticated-orcid":false,"given":"Jinchi","family":"Tang","sequence":"first","affiliation":[{"name":"Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0421-9478","authenticated-orcid":false,"given":"Fleur","family":"Boel","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiel M. A.","family":"van Buuren","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0786-0348","authenticated-orcid":false,"given":"Noortje S.","family":"Riedstra","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7129-9702","authenticated-orcid":false,"given":"Myrthe A.","family":"van den Berg","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6293-6707","authenticated-orcid":false,"given":"Jos","family":"Runhaar","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sita","family":"Bierma\u2010Zeinstra","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0645-093X","authenticated-orcid":false,"given":"Rintje","family":"Agricola","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106085"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2013.114"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2021.06.007"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-020-3049-3"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.12112479"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325967120938312"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2013.11.007"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-018-5968-z"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.96B4.32194"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocarto.2024.100510"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2024.08.003"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu177"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.096164"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.84B4.0840556"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.89B10.19405"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2015.10.007"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ostima.2024.100181"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24563"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19980730)17:14<1623:AID-SIM871>3.0.CO;2-S"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1624-x"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520988151"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-013-9866-z"},{"key":"e_1_2_7_24_1","unstructured":"NevittMC FelsonDT LesterG.The Osteoarthritis Initiative: Protocol for the Cohort Study. 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